Göbel Carl H, Heinze Axel, Karstedt Sarah, Clasen Svenja, Göbel Hartmut
Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany.
Kiel Migraine and Headache Centre, Kiel, Germany.
Pain Ther. 2021 Jun;10(1):567-576. doi: 10.1007/s40122-021-00242-3. Epub 2021 Feb 25.
Occipital nerve stimulation (ONS) is a specific form of peripheral neuromodulation used in the treatment of chronic pain disorders. A particular field of application is in the therapy of treatment-refractory headaches, especially of chronic migraine. The precise mode of action is unknown. It is presumed that central and peripheral sensitization are reduced in patients with chronic headache. The aim of this study was to examine the effect of ONS on pain-modulatory mechanisms in the trigeminocervical area in patients with chronic migraine.
In a balanced repeated measurements design in eight patients with chronic migraine with and without active ONS, we analyzed which effects ONS had on the orbicularis oculi reflex dynamically elicited by corneal air flow.
The orbicularis oculi reflex in active ONS (7.38 ± 20.14 eyelid closures/minute) compared to inactive ONS (18.73 ± 14.30 eyelid closures/minute) is significantly reduced (p = 0.021).
The results show that under active ONS compared to inactive ONS in patients with chronic migraine, the orbicularis oculi reflex, dynamically triggered by a standardized air flow, is significantly reduced. This suggests that ONS is able to directly counteract the trigeminally mediated central sensitization in chronic migraine and protectively reduce the effects of aversive peripheral stimulation.
枕神经刺激（ONS）是用于治疗慢性疼痛疾病的一种外周神经调节的特殊形式。一个特定的应用领域是治疗难治性头痛，尤其是慢性偏头痛。其确切作用方式尚不清楚。据推测，慢性头痛患者的中枢和外周敏化作用会减弱。本研究的目的是检验枕神经刺激对慢性偏头痛患者三叉颈区域疼痛调节机制的影响。
在一项针对8例慢性偏头痛患者的平衡重复测量设计中，无论是否进行主动枕神经刺激，我们分析了枕神经刺激对由角膜气流动态诱发的眼轮匝肌反射有哪些影响。
与非主动枕神经刺激（每分钟18.73±14.30次眼睑闭合）相比，主动枕神经刺激时的眼轮匝肌反射（每分钟7.38±20.14次眼睑闭合）显著降低（p = 0.021）。
结果表明，在慢性偏头痛患者中，与非主动枕神经刺激相比，主动枕神经刺激时，由标准化气流动态触发的眼轮匝肌反射显著降低。这表明枕神经刺激能够直接对抗慢性偏头痛中三叉神经介导的中枢敏化，并保护性地减轻有害外周刺激的影响。
